Pneumococcal pneumonia in hospitalized patients. Clinical and radiological presentations
S. Ort, J. L. Ryan, G. Barden and N. D'Esopo
The clinical and radiological features of pneumococcal pneumonia were
studied in 94 hospitalized patients. Fifty-seven (61%) had a
bronchopneumonic pattern on roentgenogram, and 37 (39%), a lobar pattern.
Eighty-two (87%) of the patients in both roentgenographic classifications
had one or more underlying disease states. There was no difference in the
frequency of heart disease, diabetes, chronic pulmonary disease, or
malignancy between the two categories. Sputum Gram's stains were also
similar in both patterns. Twenty (54%) of the 37 patients with the lobar
pattern were bacteremic compared with only five (9%) of the 57 patients
with the bronchopneumonic pattern; all five patients with bronchopneumonia
and bacteremia had an associated malignancy. Although a lobar pattern is
usually emphasized in the diagnosis of pneumococcal pneumonia, this study
showed that the majority of patients hospitalized with pneumococcal
pneumonia had a roentgenographic bronchopneumonic pattern rather than the
classic lobar pattern. Thus, patients with the bronchopneumonic
pneumococcal pneumonia pattern may be underdiagnosed. The implications are
important both for treatment and for epidemiologic data used in the
selection of pneumococcal types for prophylactic vaccines.
